Obesity is Equivalent to Heavy Smoking as a Primary Cause of Premature Death

by Barbara J. Moore, PhD

Most people would agree that 57 years old is
too young to die. But a 2009
study of more than 45,000 Swedish
male adolescents,
followed from ages 19 to 57, found a
significantly higher mortality — more
than double the death rate — in those
who were heavy smokers (over 10
cigarettes per day) and also in those who were
obese (body mass index or BMI of 30 or
higher).1

This study has caused quite a stir in the
public health community because the risk of
early death in obese individuals was found to
be as high as it was in heavy smokers — a
finding that surprised those who see smoking
as the far greater threat to health. But that
was what these researchers found. They also
found that overweight (BMI of 25.0 to 29.9)
was comparable to light smoking (1 to 10
cigarettes per day) in predicting
premature mortality.
The data are summarized in this
table.

The strengths of this study include:

The study was a large nationwide cohort
study of 45,920 people who were young and
otherwise likely to be in good health.

It was conducted in a developed country
known for rigorous data collection and
control procedures.

It was conducted in virtually all
eligible Swedish males of the target age
since registration in the military is
compulsory for males.

It controlled carefully for
socioeconomic status.

It measured height and weight in
order
to calculate body mass index (BMI) as an
indicator of obesity/weight status, whereas
the major weakness of other studies is
reliance on self-reported height and weight
data, which are notoriously unreliable.

The weaknesses of this study include:

It was a study only of males.

The study relied on self-report for
smoking status.

There was possible misclassification of
obesity status since some highly muscular
individuals have a high BMI but are not
overly fat. This limitation was addressed by
these researchers by evaluating muscular
strength in all subjects in order to control
for muscularity when the data were analyzed.

Obesity or weight status and smoking
status were evaluated only at the start of
the study, and not thereafter, making this
the most serious weakness of the study. Thus,
some normal weight people may have gained
weight and some obese people may have lost
weight soon after initial measurement.
However, this would have raised mortality in
the normal weight group and lowered mortality
rates in the obese group, thus minimizing
differences in mortality rather than
accentuating them. The same argument applies
to nonsmokers who might have started smoking
and to smokers who may have quit. This would
also likely minimize differences in mortality
rather than accentuate them. However, we
agree that this weakness does make
comparisons of smoking-related mortality and
weight-related mortality less reliable.

In conclusion, the authors point out that in
adolescents as well as adults, the two most
important preventable causes of death are
smoking and obesity, at least in the
developed world. Whether the risk of obesity
is equivalent to the risk of heavy smoking is
not entirely clear, but this large study in
young men is very carefully conducted and
suggests that it is. We agree
with the authors that obesity and smoking
among adolescents are important targets for
intensified public health initiatives.

Juvenal, the ancient Roman poet, first coined
the phrase "a sound mind in a sound body" to
summarize what he believed to be an important
link between exercise and cognitive health
—
that is, sound mental functioning. This
ancient philosophy has long been a primary
concern of parents, educators and
administrators throughout the US.
Nonetheless, in a misguided attempt to
facilitate the development of a "sound mind,"
physical activity opportunities for children
— instructional time for physical education
and recess — are being sacrificed in many
school systems.

Greater emphasis on academic instruction has
been proposed in order to increase student
test scores.1 However, results
from the
Trends in International Mathematics and
Science Study [TIMSS] indicate that more
instructional time may not be effective in
increasing academic performance.2 In
comparisons of student performance, US
rankings dropped from 19th to 37th in
math and from 18th to 35th in science between
the years of 1999 and 2008.

The "sound body" of today's youth is being
compromised. Over 65% of children and
adolescents fail to perform physical activity
of a sufficient intensity or duration. Fully
25% are classified as sedentary and 17% are
obese.3 What is the relationship
between
intellectual development and physical fitness?

Recent studies have shown positive
relationships between higher levels of
physical fitness and academic performance
4,5,6 and that increasing
physical education
time is not detrimental to achievement in
other academic areas.7 The 2005
California
Department of Education study of 884,715,
fifth, seventh and ninth graders found that
as the students' level of physical fitness
improved so did their mean achievement level
on state tests.6
Neurophysiologists have also
indicated that physical activity strengthens
the functioning of the basal ganglia,
cerebellum and corpus callosum — key areas
related to cognitive function in the brain,
and that exercise enhances the brain's
ability to communicate and transfer
information.8-13

Physical activity is only one of many factors
related to how a child will perform
academically. Variables such as the learning
environment, teaching methods, parental
involvement, nutrition, quality of
instruction in physical education, and
supervision in physical activity settings
should all be considered, as they all have an
impact on a child's intellectual development.
As parents, educators, administrators and
community members concerned about the
development of the "whole child," we need to
look at education through a broader scope.

Learning is an inseparable partnership
between the brain and the body and movement
is crucial to every brain function including
memory, emotion, language, and
learning.14
Reducing the ability for kids to move during
the school day has a negative impact on their
physical health, and it impairs cognitive
development, as well. As funding for physical
education programs and teachers declines,
Juvenal's adage of 1900 years ago is more
important now than ever. Shaping the "sound
minds" and "sound bodies" of the future
depends on a balanced approach to education
—
one that acknowledges the link between
physical competency and academic achievement.

Derrick Mears, Ph.D., A.T.C. is Assistant
Professor of Teacher Education, Physical
Education at Western Washington University in
Bellingham, WA

A distressed young mother contacted me two
years ago when her child started school. She
was dismayed by the fact that hardly a week
would pass without a birthday or holiday
celebration at school. These celebrations
always included cakes, cookies, soda or other
foods or beverages she preferred her child
not consume at school. Another young mother
said that even sporting events for her kids
were an excuse for eating chips and drinking
soda (pop), and each parent was expected to take
turns contributing. She reported that the
pressure to adhere to low nutritional
standards for these foods and beverages was
intense.

Federal law requires every school district to
have a wellness policy. The policy should
include ALL foods and beverages available at
school, but this is often not the case. As a
parent, you have a right to see this policy
and to determine whether it addresses school
celebrations to your satisfaction. If it does
not, we encourage you to join the wellness
committee at your child's school to help
amend the wellness policy and set appropriate
nutritional standards for food and beverages
served at school celebrations and other events.

In medium bowl, combine remaining mozzarella
and Parmesan cheese with all of the cottage
cheese. Mix well and set aside.

Combine tomato sauce with remaining
ingredients. Spread thin layer of tomato
sauce in bottom of baking dish. Add a third
of noodles in single layer. Spread half of
cottage cheese mixture on top. Add layer of
zucchini.

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